Metastatic signet-ring cell cancer of the bladder responding to chemotherapy with capecitabine: case report and review of literature

Abstract

Signet-ring cell cancers deriving from the bladder are rare entities and usually present with advanced incurable disease and associated poor outlook. No standard effective chemotherapeutic option has been described largely due to the rarity of this malignancy. We report a case of a patient with metastatic bladder cancer, signet-ring cell variant. The patient progressed rapidly on standard first-line bladder cancer chemotherapy with gemcitabine and carboplatin. He responded well to second-line capecitabine with a clinically meaningful progression-free survival.

Fig. 1.

Axial computer tomographic images. Corresponding imaging sections before (A/C) and at end (B/D) of capecitabine chemotherapy are demonstrated. Marked bladder wall thickening with significant pelvic/inguinal lymphadenopathy and multiple liver metastases are noted (red arrows) on baseline computer tomography.

Fig. 2.

Pathology and Immunohistochemistry. The microscopic presence of 2 different malignant cell populations (A) is seen on hematoxylin and eosin stain on low power field (signet-ring cells are marked with open arrow, poorly differentiated urothelial carcinoma with closed arrow). Signet-ring cells stained positive for carcinoembryonic antigen on immunohistochemistry (B).

Fig. 3.

Tumour marker kinetics during chemotherapy. Serial serum levels of carbohydrate antigen 19-9 and carcinoembryonic antigen are shown immediately prior to gemcitabine/carboplatin (open arrow) and following chemotherapy cycles with capecitabine (closed arrows).